New Orleans offers help to doctors fearful of new drug law; Murrill says ‘problem doesn’t exist’

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NEW ORLEANS — As more health care providers come forward with concerns about a new Louisiana law reclassifying life-saving medication as a controlled dangerous substance, city officials in New Orleans are working to help doctors and investigating delay of care issues.

The New Orleans City Council filed a request Monday with the city’s health department to “investigate and study any delay of care issues related to the classification of mifepristone and misoprostol as dangerous Schedule IV controlled substances.”

In May, Gov. Jeff Landry signed legislation reclassifying misoprostol and mifepristone as Schedule IV controlled dangerous substances. Both drugs were targeted because they are used in medication abortion, but they have multiple other uses. Misoprostol is commonly used to treat postpartum hemorrhaging, and the new law has doctors and pharmacists scrambling to come up with new protocols before the law goes into effect on Oct. 1.

City Council President Helena Moreno and her six colleagues have asked Avegno’s department to establish a “complaint-based reporting system” so that patients, pharmacists and health care providers can report challenges with accessing the medications. The request, will go before a council committee Wednesday and the full council Thursday.

“We want to make sure that physicians and pharmacists have an outlet to report concerns or adverse events,” Dr. Jennifer Avegno, director of the New Orleans Health Department, told the Illuminator. “Because what we’re hearing from them is that they’re often not comfortable going to their hospital, or if, even if the hospital knows about it, they’re not comfortable being public about it because of the fear of repercussions.”

Avegno said she has heard from doctors, pharmacists and hospitals who are “not comfortable going to a state agency given that they feel that this state has already established that it is looking to criminalize doctors .”

“They really want a place where someone will listen, help them identify what the barrier was, and we are going to do that in the safest way possible,” said Avegno, an emergency medicine physician, “We are doing our due diligence to make sure that no one is put at risk because they want to elevate a concern, challenge, or a bad outcome.”

Some hospitals have preemptively pulled the lifesaving medication from their obstetric hemorrhage carts, the Illuminator previously reported.

“Our state already has some of the highest national levels of maternal mortality, and negative maternal outcomes, and this new state legislation will only exacerbate this crisis,” Moreno said in a statement. “I partnered with the Health Department to ensure that any delays of care that put women’s lives at risk are immediately identified. Even a small delay when a patient is hemorrhaging, losing large amounts of blood, can have grave consequences.”

Attorney General Liz Murrill, however, thinks New Orleans is acting unnecessarily. Her office is tasked with defending state laws, and she has made clear her support for the new drug classification law.

“The New Orleans City Council is manufacturing a problem that doesn’t exist,” Murrill said in a statement to the Illuminator . “The Louisiana Department of Health guidance is clear that no care should be delayed — and the medication, as long as it’s secure and accounted for, can and should be used for emergencies.”

When asked about a response to Murrill’s comments, Avegno said, “Maternal health is a very real problem in Louisiana, the entire state, not just New Orleans. That problem exists, and I think denying that problem is extremely problematic.”

On Tuesday, Murrill also released a lengthy statement claiming that the media, political organizations and candidates have spread disinformation and “attempted to sow confusion and doubt” in order to “further their own financial and/or political agendas.”

“This legislation does not limit a healthcare provider’s ability to use, prescribe, or fill these medications for legitimate health purposes nor does it impose restrictive burdens on access for emergency purposes,” Murrill said in her statement. “To be clear: nothing in Louisiana laws stands in the way of a doctor providing care that stabilizes and treats emergency conditions. Any statements to the contrary are flatly incorrect.”

Avegno noted that Murrill is not a health care professional.

“Without being trained in how to care for medical emergencies, a layperson would not necessarily have the same understanding of how limiting access can affect them,” she said. “There is a real and palpable difference between accessing controlled substances and non-controlled substances. Most providers, physicians or pharmacists would agree.”

Avegno also pushed back on Murrill’s assertion that the Louisiana Department of Health’s guidance on the new law is clear.

“LDH’s letter has prompted a lot of questions from providers to us because they didn’t know who to reach out to at LDH,” the doctor said. “It is not clear, so we want to do our best to be able to provide as many health professionals as possible with what we know based on how these drugs are used in legal maternal practice. We want to have a discussion so that everyone has a little bit better understanding of how to safely practice medicine after October 1.”

When the state health department first released its memo, doctors told the Illuminator they didn’t find it helpful because it did not give specific guidance about workflow challenges hospitals encounter with controlled substances, including how to keep track of the drugs on the carts and how often to take inventory of them. It also did not detail what diagnosis codes are required in order to fill a prescription.

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The New Orleans Health Department is hosting a virtual learning session Thursday for physicians and pharmacists on how to reduce barriers to access to misoprostol and mifepristone for medically necessary and legal use, and how to troubleshoot issues.

Avegno told the Illuminator that last week, she invited the Louisiana Department of Health to participate but has yet to hear back.

“The argument that these drugs are fine if they’re locked up doesn’t hold up,” she said. “If you lock something up down the hall in a cabinet, that’s not immediate access. The maternal morbidity and mortality crisis is not manufactured, it is very real, and you can ask the loved one of any family that has suffered from that.”